Posts Tagged ‘Bipolar disorder’

A recent study has found that cognitive behavioral therapy (CBT) and supportive therapy are equally effective in treating the symptoms of bipolar disorder.

Researchers, led by Thomas D. Meyer, PhD, at Eberhard Karls Universität in Tübingen, Germany, wanted to investigate the effectiveness of currently available treatments for the disorder.

Bipolar disorder is a mental illness in which the sufferer experiences extreme and abnormal mood swings, from manichighs to potentially dangerous lowdepression. Over five million people in the United States suffer from bipolar — about 1.6 percent of the population. It is the sixth leading cause of disability worldwide, and causes significant stress on families and relationships.

Earlier studies have proven that CBT is an effective treatment for the disorder, but these studies did not compare CBT to other types of treatments.

The randomized controlled trial included 76 patients with bipolar I or bipolar II. Patients were given either CBT or supportive therapy for 20 sessions over nine months. The participants were then followed for up to two years.

Both CBT and supportive therapy are psychoanalytic therapies that teach the patient to increase healthy thought processes and behaviors and decrease upsetting thoughts and behaviors.

The results show that the participants had equal amounts of symptom improvement regardless of the type of treatment. Relapse was also similar for patients in both therapy types.

During the 33 months of the study, 64.5 percent of the participants relapsed regardless of the type of therapy. Relapsing was associated with having bipolar II, the number of previous episodes, and the number of sessions attended before the relapse.

The researchers conclude that both therapies share some characteristics such as mood monitoring and educational components.

These factors might explain the overall benefits of these types of treatments and why they had equally positive effects.

Like this:

ScienceDaily (Mar. 2, 2010) — It seems to make perfect sense: happy people are trusting people. But a new study suggests that, in some instances, people may actually be less trusting of others when they are in a pleasant mood.

“A person’s mood may determine how much they rely on subtle — or not so subtle — cues when evaluating whether to trust someone,” said Robert Lount, author of the study and assistant professor of management and human resources at Ohio State University’s Fisher College of Business.

In five separate experiments, Lount found that people in a positive mood were more likely than those in a neutral mood to follow cues or stereotypes when determining whether they should trust someone.

If you are predisposed to trust a stranger — because he belongs to the same club as you, or he has a “trustworthy” face — a happy mood makes you even more likely to trust him.

But if you are predisposed to not trust him, a positive mood will make you even less trusting than normal.

“I think the assumption is that if you make someone happy, they are going to be more likely to trust you. But that only works if they are already predisposed to trust you,” Lount said.

“If you’re a professional meeting new clients, you may think if you buy them a nice lunch and make them happy, you’re building trust. But that can actually backfire if the client has some reason to be suspicious of you,” he said.

The study appears in the March 2010 issue of the Journal of Personality and Social Psychology.

All five experiments involved undergraduate students who took part in various scenarios in which they were put into positive or neutral moods, and were then given the opportunity to show trust or distrust toward a stranger.

In one study, for example, participants were first asked to write one of two short essays. Some wrote about an experience that made them happy while others wrote about what they did in a typical day. Those writing tasks were previously shown to put people in a happy or neutral mood.

The participants were then shown a picture of a person and asked a variety of questions designed to find out how much they would trust him. For example, one question asked how likely the participants thought it would be that the person would intentionally misrepresent their point of view to others.

All the pictures were created by a software program that made the faces appear trustworthy or untrustworthy to most people. A trustworthy person had a round face, round eyes and was clean shaven. An untrustworthy person had a narrow face, narrow eyes and facial hair.

The results were striking: participants in a positive mood evaluated the person with the trustworthy features as more trustworthy than did those in a neutral mood.

Conversely, the happy people were less trusting of the person with untrustworthy features than were those in the neutral mood.

“For those in a good mood, it all depended on the cues that the pictured person gave that suggested whether he was trustworthy or not,” Lount said.

But why would happy people rely more on stereotypes and cues to evaluate a person’s trustworthiness?

“You feel like everything is going OK, so there is no reason to search out new information. You can rely on your previous expectations to guide you through a situation.”

Another one of the experiments provided evidence for that theory. In this experiment, the participants were put in a happy or neutral mood. They were then asked to memorize a nine-digit number, which they would be asked to repeat in a few minutes.

Then, they were shown pictures of untrustworthy faces and asked to rate how trustworthy each face looked.

In this case, people in a neutral mood responded much as did the happy people in the previous experiments — they rated untrustworthy faces as even more untrustworthy.

“In this experiment, people’s minds were busy trying to remember the number so they processed information differently than they normally did,” Lount said.

“They relied more on the cues, just like happy people did.”

Lount said people aren’t aware of this process and don’t even know how their mood is affecting how they evaluate others.

“You need to be careful, especially when you’re happy. You should ask yourself how your mood may be affecting your willingness to trust or distrust another person.”

Like this:

Of primary and significant importance is that family and friends be watchful for signs of suicidal behavior. Suicidal behavior is not always obvious and is seldom predictable, but there are some signs that can trigger family and friends to ask more direct questions, such as, “Are you feeling suicidal at all?” It is okay to ask patients directly whether they are suicidal; there is not any danger that you will “put ideas in their head” as some family members and friends may fear.

Patients’ risk for committing bipolar suicide may be elevated if they display any of the following behaviors:

Talking about how they feel suicidal or want to die, or think the world would be a better place without them in it.

Feeling hopeless, that nothing will ever change or get better

Feeling helpless, that nothing one does makes any difference

Feeling like a burden on family and friends.

Abusing alcohol or drugs (this is a risk because drugs increase the likelihood that impulsive actions will take place)

Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for their death)

Writing a suicide note

Putting themselves into harm’s way when this is not necessary, or into situations where there is a danger that they will be killed or seriously harmed.

While some bipolar suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out. It is very difficult to prevent the carefully thought out variety of suicides, but some basic precautions can help to minimize the risk for impulsive suicides. The simplest thing to do is to help patients to remove tools that they might use to harm themselves from their home. Guns should not be in the home, for instance (or if they must be in the home, they should be unloaded, and locked up. Unnecessary medications should not be available, and even necessary medications should not be available in quantities that could cause death. Similarly, razors, ropes, cables, saws, blades and other tools that might be used to slash or hang oneself should be removed from the home. There is not any practical way (short of complete imprisonment) to prevent someone from committing bipolar suicide if they are motivated to do so. A motivated patient can throw themselves in front of a car or train, or hang themselves with a shoelace. It is impractical to remove all such tools from patients’ lives. However, taking some precautions to put obvious suicide tools out of immediate reach can and does reduce some suicidal risk.

When patients indicate that they are feeling suicidal, or are experiencing suicidal thoughts, immediate action is appropriate:

Call the patient’s doctor or therapist, the local psychiatric (or medical) emergency room, or 911 right away so as to get immediate help and assistance.

Make sure the suicidal person is not left alone

Make sure that the suicidal person does not have access to large amounts of medication, to weapons, or to other items that could be used for self-harm (e.g., knives, etc.)

Because it is so difficult to accurately predict when people are actually at risk for committing suicide, it is generally appropriate to treat all instances of suicidality as real and serious threats, and to intervene every time. The risk of intervening every time, however, is that bipolar patients cease to talk about their suicidal thoughts after several false alarms, because they no longer want to be shuffled off to the hospital.

Many patients will have ongoing low-level suicidal thoughts for long periods of time and not be in acute danger of acting on them. On the other hand, it is always possible for patients to impulsively act on long-standing suicidal thoughts if they happen to be triggered by particularly disturbing events or at an impulsive point in their mood cycle. The risk for bipolar suicide is highest when patients are in an impulsive state.

Family members and friends have to use careful and conservative judgment when deciding whether to call in the professionals so as to balance patients’ safety against damage to their relationships with patients if suicidal ideation should turn out to be a false alarm. When there is any doubt as to the seriousness of the suicidal threat, it is best to err on the side of safety and to call in the professionals.

Bipolar patients’ suicidal crises are terribly frightening events for family and friends to endure. It is important that family and friends realize that such crises are a normal (if unfortunate) part of more severe bipolar illnesses, and that they will generally pass if the patient experiencing them can be helped through the crisis period.

Share this:

Like this:

The family and friends of bipolar patients may become frightened and aggravated by the impulsive and self-destructive behaviors associated with bipolar disorder they see played out again and again, but they also generally want to help. This is a good thing, because having access to the help and support of family and friends can make or break bipolar patients’ chances for keeping themselves maximally stabilized and healthy. Family and friends provide social support and encouragement, which tend to provide a moderating influence on mood (e.g., helping mood to keep from sinking too low or too high). This moderating influence takes on several different forms.

First, support takes the form of monitoring. Family and friends are in a perfect position to help bipolar patients to monitor their moods. Often, family and friends will know that moods are shifting before patients will themselves, and can help make the patient aware that they are again entering into a dangerous period. Family and friends can monitor patients’ medication-taking behavior, and can help patients either get back on bipolar medication when they stop taking it, or help marshal resources to help cope with the mood episodes that are likely to occur when patients are not medicated.

Second, family and friends can persistently encourage patients to comply with bipolar treatment and professional recommendations (taking bipolar medications as prescribed, attending bipolar therapy groups, etc.). Treatment compliance is important at all times (as treatment during periods of limited mood symptoms can help prevent future mood swings from occurring). However, helping patients to comply with bipolar treatment recommendations is especially important when mood symptoms are waxing, as professional treatment offers the best opportunity to limit symptom severity. Patients frequently complain that they don’t like the way that medication makes them feel, and become motivated to stop taking it. Stopping medication also stops any prophylactic (preventative) effect that the bipolar medications provide, setting patients up for new mood cycles, sometimes with tragic results. Family and friends can help defuse this sort of situation by reinforcing professionals’ treatment recommendations, including the importance of taking medicine as prescribed.

Third, family and friends can help support bipolar patients by helping them to “reality-test”; to raise their awareness concerning times when patients’ own judgments are faulty, or when they are acting in odd, bizarre ways, and help patients to make more sound judgments. Often individuals suffering from bipolar disorders make excuses for their behavior, blaming other people or situations for their bipolar symptoms. Family members and friends can help point out this tendency towards externalization to patients when and if it occurs, so as to give the patient some objective perspective on their behavior.

Fourth, family and friends can initiate an intervention when necessary. This is to say, they can make psychiatrist appointment, or an appointment for bipolar therapy, and even accompany patients to see the doctor or therapist when this becomes necessary. This helps the patient get connected to treatment and with the presence of a known person, may alleviate the anxiety of seeing a professional. Family and friends can also help make arrangements for hospitalization when hospitalization becomes necessary.

Interventions are not just useful during times of crisis. During normal mood phases of bipolar disorder, family and friends can help bipolar patients to plan for what they can do to minimize their future mood cycle intensities, and help them implement the various components of that plan. For instance, if the mood stabilizing plan calls for regular exercise, family and friends can offer to be an exercise partner, and thus increase the chances that exercise will actually take place (because it is generally more pleasant to exercise when you have a partner with you). Ongoing encouragement and bipolar support are crucial to patients’ stability.

Like this:

Persons with Bipolar Disorder in the grip of severe mood episodes are often unable to help themselves or often even to stop themselves from acting out in ways that may damage their health. However, these same people can do a whole lot to help insure their health and safety as their bipolar symptoms stabilize (generally with the help of bipolar medication therapy). Self-help methods include any activities that patients may engage in which will help keep their moods maximally stable. Useful methods that patients might explore would include:

Regular attendance in psychotherapy and/or regular self-monitoring exercises designed to help promote awareness of moods (talking about problems and problem solving help to prevent depression)

Avoidance of mood-altering drugs, including alcohol.

Self-help approaches can help patients increase their ability to resist extremes of emotion (insomuch as that is possible to accomplish), and also help patients to recognize when a shift in mood is about to occur so that they may take steps to minimize the severity and impact of that oncoming mood.

Participation in psychotherapy, in community activities, and in bipolar support groups provides patients with social support and fellowship opportunities (an experience that most people find very meaningful) that help them to become more resilient in the face of depression, and which provide opportunities for self- and other-monitoring of their behavior, and for reality testing. Patients who are interested in locating a bipolar therapy group can speak to their doctor or therapist who may be able to provide a referral. Patients desiring face-to-face bipolar support group participation may also seek group referrals from mental health associations including:

Like this:

Family Focused Therapy or FFT is a hybrid of two forms of psychotherapy. It is both a variety of psychoeducation (a type of therapy whose main goal is to teach patients and their families about the nature of their illness), and also a variety of family therapy.

Family therapies are distinguished from other forms of therapy by their attention to family dynamics and relationships as contributing factors that help or hurt illness. Family therapies are sometimes referred to as ecological therapies because they recognize that individuals and their bipolar disorder (in this case) cannot truly be considered to be independent entities separate from the family systems that contain them.

Family Focused Therapy starts with a deep appreciation of the ways that patients’ family system and the complicated web of relationships found therein may support patients’ conditions, or alternatively, exacerbate them. FFT therapists work to identify difficulties and conflicts within the family that may contribute to patient and family stress, and then help the involved family members to find ways to resolve those difficulties and conflicts.

The term “expressed emotion” refers to critical, hostile, or over-involved attitudes and behaviors that family members may have toward or act out with other family members who have psychiatric disorders. Family focused therapists work to help family members to become aware of and bring under control any expressed emotion they may be acting out.

For example, the parents of an adolescent daughter with bipolar disorder may be quite upset by their child’s illness, and as a result, motivated to act in an over-controlling manner that the child rebels against. The daughter’s rebellion adds significant stress to her already complicated condition. Recognizing this dynamic, the family focused therapist might advise the parents to find less controlling ways to express their caring and concern, and help them to manage their own stress in a manner more independent from their daughter than they were able to manage previously.

Family focused therapists also educate all family members about the nature of bipolar disorder, bipolar treatment, and ways that family members can best support their affected member. For example, the therapist might teach family members about the nature of manic and depressive mood swings, about the differences between Bipolar I Disorder and Bipolar II Disorder, and about the need for bipolar medications to be the primary means of therapy. In addition to providing lecture or handout style educational information, therapists may also provide assistance and training to support the family’s development of communication, and problem solving skills.

Bipolar disorder is a very serious condition associated with impulsive and self-destructive behavior. Bipolar suicidal thoughts behaviors are frequent, as are impulsive sexual behaviors and reckless spending. Not surprisingly, families are frequently deeply affected by their bipolar member, and themselves experience a range of deeply felt emotions, not the least of which is a sense of helplessness to fix bipolar symptoms. Such helplessness can easily turn into anger, frustration and aggravation expressed towards the bipolar family member.

Caring for bipolar family members can easily become exhausting and infuriating. Family members can get burned out from trying to help, particularly if the patient is a reluctant patient. They may stop supporting their bipolar family member. Family focused therapists look for these sort of feelings and interactions (or lack of interactions), work to re-channel any aggression that may be present, promote re-engagement of family members who have checked out, and in general, promote a balanced blend of acceptance of the bipolar patient’s limitations, as well as the need for the patient to take age-appropriate responsibility for his or her own well-being. Addressing family emotion in FFT can be a powerful tool for fostering stability within the family unit.

Interpersonal and Social Rhythm Therapy (IPSRT) is based on the observations that bipolar disorders are essentially body rhythm disturbances, and that altered body rhythms (e.g., circadian rhythms, seasonal rhythms, and social/occupational rhythms) can lead to mood disturbances.

Body rhythm disturbances such as insomnia and other sleep disturbances, can be corrected or managed by helping patients to set up and stick to healthy sleep routines. As sleeping routines are stabilized, many body rhythms problems tend to go away.

Patients in IPSRT are taught to keep a bipolar mmood chart to track their mood states and their daily activities and body rhythms. Patients record when they eat, sleep, shop, etc. on a social rhythm metric chart. They also complete an interpersonal inventory, noting social interactions, such as conflicts and stresses that have an effect on their daily body rhythms and thus on their bipolar mood disorder.

For instance, an argument with one’s spouse is recorded, particularly if that argument resulted in insomnia and agitation. The bipolar mood chart is analyzed and discussed during psychotherapy sessions, where it becomes an important tool for raising awareness of the inter-relationship between body rhythms and mood.

Therapists help patients to establish and maintain steady and stable routines such as taking bipolar medication consistently and going to sleep at regular times. They also help patients with bipolar disorder to recognize the sorts of activities and interactions that cause their body rhythms to become disturbed so that these activities and interactions can be avoided. For some patients, this self-monitoring and problem-solving variety of bipolar therapy is effective in helping prevent recurring mood episodes.

Like this:

Psychiatrist John Gartner has an interesting outlook on hypomania, one that is much more positive than the average viewpoint. Gartner has a lot to say in his book “The Hypomanic Edge: The Link Between (a little) Craziness and (a lot of) Success in America.” He believes that many of the most influential people in the past have been people who were actually hypomanic.

Hypomania is the milder form of mania, different in that it usually does not interfere with one’s functioning and does not result in hallucinations or delusions. Those with Bipolar II disorder alternate between depression and hypomania.

Those included in his diagnosis of hypomania are Christopher Columbus, William Penn, Andrew Carnegie, Alexander Hamilton, David Selznick, and Craig Venter. But this is only a portion of those who Gartner has diagnosed as hypomanic.

Some argue against Gartner’s claims that hypomania gives way to success. “‘Is the suffering of the illness necessary in order to motivate or inspire great art?’ asked Dr. Michael Thase, a professor of psychiatry at UPMC’s Western Psychiatric Institute and Clinic. ‘It is fair to say that if people have illnesses that are placing their lives in danger, they should be treated'” (Semuels, 2005).

Gartner also claims that America, due to its high influx of immigrants has a greater population of hypomanics. The idea is that immigrants made a great risk when choosing to move to America, and therefore many of them may have hypomanic tendencies. It is a good hypothesis, but it also lacks the scientific data needed to make it factual.

As Semuels (2005) puts it “It’s that mentality — that hypomanics are an elite bunch who hold the future of America in the palms of their always-moving hands — that has caused Gartner the most trouble, by giving an excuse to people with strange and often irritating habits to hold onto them as part of their genius.”

As astounding as the potential link between hypomania and success is, it should be noted that hypomania can often be destructive rather than creative. Having one’s hypomania treated should come first and foremost. There has been no scientific evidence that shows that taking medication for hypomania reduces one’s creativity; creativity is something within oneself, a part of your personality. Hypomania may sometimes just highlight how creative a person is, but it does not manifest creativity out of nothingness. I would argue that creativity comes from the individual, not the illness, although I admit that this is a debatable fact.

Despite the cracks in Gartner’s argument he raises many interesting points. Maybe the world does owe a lot of its success to hypomania. Unfortunately we won’t truly know until hypomania and its effects on “success” are studied.

Like this:

People with bipolar disorder who have experienced mania or hypomania (the state leading up to mania) describe periods of emotional intensity, creativity, energy, and productivity as appealing aspects to being bipolar. These “advantages” to bipolar symptoms can be so strong that bipolar patients may actually stop taking their medications because they miss this side to the disease.

While a small number of bipolar patients stay in the state of hypomania (a pre-manic phase) without progressing to the more dangerous heights of mania, the majority of people with bipolar disorder are not so lucky.

“The drawbacks to bipolar disorder far outweigh any benefits,” says psychiatrist Charles Lake, MD, PhD, professor in the department of psychiatry and behavioral services at the Kansas University Medical Center in Kansas City.

Symptoms of depression are far more common and frequent among people with bipolar disorder than the highs of mania.

Dr. Lake offers the example of artist Vincent van Gogh to demonstrate the course that mania can take. Although van Gogh was never officially diagnosed with bipolar disorder, certain patterns of depression followed by high-energy productivity and creativity suggest bipolar disorder. While his moods improved and moved toward mania, he was incredibly productive, says Lake, producing works of art that are admired and beloved to this day. But as the days passed, his brushstrokes would become less controlled and ultimately he was unable to paint at all. Meanwhile, his personal life bore many of the hallmarks of bipolar disorder, including suicide at 37.

Understanding the Bright Side

Here are some of the elements of bipolar disorder that are considered advantages, for a brief period:

Productivity. People with bipolar disorder sleep less as they become manic and have more energy. As a result, they are often more productive than their peers, at least for a while. The lack of sleep and high-energy work can eventually lead to burnout and may contribute to symptoms of psychosis, such as paranoia and hallucinations.

Confidence. Feeling more self-confident is one of the benefits described by people with bipolar disorder. Unfortunately, as mania increases, this self-confidence can become unrealistic fantasies about power and success, leading to poor life choices and impulsiveness.

Charm. Along with greater energy and self-confidence, people with bipolar disorder may be more outgoing and charming as their mood improves. This can draw people to them, making them the life of the party (for a while). However, as mania progresses, increasing irritability, impulsiveness, irrational behavior or speech, and risk-taking also can drive people away.

Euphoria. Intense joy and pleasure in life, including a heightened awareness of details, may also be experienced by bipolar patients as they approach mania. This perception of the world in bright and beloved detail is often what patients cite as the most missed element of bipolar disorder.

Insight. Many people with bipolar disorder experience a feeling of greater intellectual ability and insight as they approach mania.

There are some known negative aspects to hypomania in addition to the positives listed above. They include irritability, carelessness, poor impulse control, and increased substance abuse.

The so-called advantages of mania can fool many people, including the patient with bipolar disorder. Patients often cite these positive experiences as reasons for not taking the medications that keep their mood stable.

Unfortunately, these perceived advantages are only temporary and, for most people, progress to increasing mania, disruptive lifestyle choices, and even psychosis. As a result, these advantages are not good reasons to stop a treatment plan. In fact, they are signs that additional treatment may be needed to prevent worsening symptoms.

Let me start by acknowledging what is well known: Manic Depression or Bipolar disorder can be a devastating illness. Affecting at least 1% of the population, it can, untreated, result in suicide, ruined careers and devastated families. Bipolar disorder is often accompanied by alcohol and drug abuse and addiction, criminal and even violent behavior. I acknowledge this, because I do not want to make light of the burden this illness places on people’s lives, their families and communities.

On the other hand, the history of the world has been influenced very significantly by people with manic depression(see my website www.wholepsychiatry.com for details)-from actors and actresses (Patty Duke, Jim Carey and Robin Williams) to Politicians (Winston Churchill, Theodore Roosevelt) to astronauts (Buzz Aldren), media mogels (Ted Turner) and perhaps even well known religious figures.

It seems clear that for at least some people with Bipolar disorder, there is an increased sense of spirituality, creativity, and accomplishment. It may be that having bipolar disorder holds great potential, if one is able to master or effectively channel the energies, which are periodically available, to some higher task. This would of course presume the ability to abstain from harmful drugs and alcohol, to have good character, and at least some supportive relationships and community networks.

It might be helpful to consider a reconceptualization. Perhaps instead of it being a disorder, we can think of people with bipolarity as having access to unusual potency. This potency will find a way to be outstanding-either in a destructive way, or in a constructive way. If such a choice is presented to the person, perhaps it can open some doors.

ScienceDaily (Sep. 4, 2011) — Recognition of bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children remains controversial despite numerous studies that have been conducted on this topic in the last fifteen years. Since the diagnosis of bipolar disorder in children has been rising for the past ten years, clinicians, researchers, parents, and others who care for children are left wondering what accounts for this dramatic increase in diagnosing pediatric bipolar disorder (Dickstein, 2010): is it better recognition of an important psychiatric disorder or is it due to overdiagnosis, misdiagnosis, or a diagnostic trend? In response to this increase, both clinical and research interest in pediatric bipolar disorders have surged, including a re-examination of the diagnostic criteria for this condition based on developmental and neurobiological findings.

Bipolar disorder is a clinically severe affective disorder, in which mood typically swings from the manic pole of euphoria and/or extreme irritability to depression and loss of interest or pleasure. Mixed illness episodes are characterized by both manic and depressive symptoms.

Bipolar disorder can be divided into two major subtypes — bipolar type I and bipolar type II -, although further extension of the bipolar spectrum may be of clinical relevance.

Bipolar type I disorder is characterized by a history of at least one manic episode, with or without depressive symptoms.

Bipolar type II disorder is characterized by the presence of both depressive symptoms and a less severe form of mania (´hypomania´).

The periods between acute illness episodes may last months or even years early in the course of the disease, but later these symptom-free periods tend to decrease. ´Rapid cycling´ is a specific course variant which is defined by the occurrence of 4 or more episodes per year.

Bipolar disorder in children and adolescents

Affecting 3-5% of the general population, bipolar disorder is a significant health problem due to its early onset and its chronic, life-long, and relapsing course associated with great impairment. In children and adolescents the illness results in considerable functional limitations and high rates of psychiatric hospitalization (Axelson et al., 2006). According to retrospective studies, 20-60% of adults with bipolar disorder had their first symptoms before the age of 20 years (Lish et al., 1994; Perlis et al., 2004).

Diagnosis

To diagnose bipolar I disorder in adolescents, adult criteria (DSM-IV) are used except that (NICE Guidelines, 2006):

Mania must be present.

Euphoria must be present most of the time (in the course of the past 7 days).

Irritability has to be noted if it is episodic, severe, results in impaired function and is not in character or is out of keeping with the context.

Clinical features such as euphoria, grandiosity, hypersexuality, racing thoughts, and decreased need for sleep are typical for mania associated with primary bipolar disorder in order to distinguish it from patients with primary ADHD (Birmaher et al., 2006).

The younger the child, the rarer is the condition of bipolar disorder. However, there is no disputing that a substantial number of pre-adolescents have symptoms of mania, usually superimposed on a number of diverse developmental and psychiatric conditions (Carlson, 2005). Recent studies have shown that ‘manic symptoms’ in children may be more common than once thought. The need to avoid confusing terminology with bipolar disorder is now consensual (Dickstein, 2010). Whether chronic manic symptoms in children represent (1) a developmental disorder that will change during adulthood; (2) an early onset bipolar I disorder; (3) a new subtype of bipolar disorder (e.g. chronic with rapid cycling); or (4) a developmental risk of later bipolar I disorder (narrow phenotype) still needs further research (Carlson, 2005).

A developmental view is crucial to understanding the complex of manic symptoms in children and adolescents.

Is there a continuum between pediatric bipolar disorder and bipolar type I disorder in adolescents?

There are very few arguments to support the hypothesis that bipolar disorder in adolescents (clearly defined illness episodes and so-called euthymic periods without any symptoms) and so-called ‘paediatric bipolar disorder’ are the same disorder or two disorders related in a common continuum. Furthermore, youths with bipolar disorder and comorbid ADHD tend to be less responsive to drugs used in bipolar disorder, suggesting that chronic manic symptoms comorbid with ADHD in youth may not be the same condition or a continuum rather than typical cycloid bipolar disorder (Consoli et al., 2007).

A novel approach suggests a phenotypic system of juvenile mania consisting of a narrow phenotype, two intermediate phenotypes, and a broad phenotype (Leibenluft et al., 2003). The narrow phenotype of mania includes mostly adolescents with clear-cut episodes of euphoric mania. On the other hand, the broad phenotype called ´Severe Mood Dysregulation´ is exhibited by younger patients who have a chronic, non-episodic course of illness that does not include the hallmark symptoms of mania, but shares with the narrower phenotypes the symptoms of severe irritability and ADHD-like hyperarousal. Indeed, these patients appear to better respond to pharmacological and non-pharmacological ADHD-like treatments (Waxmonsky et al., 2008).

This approach and subsequent research have given rise to the new diagnosis of Temper Dysregulation Disorder with Dysphoria (TDDD), which means a potential change in the diagnostic classification system DSM-V scheduled for publication in May 2013. However, a diagnosis of TDDD excludes the ADHD-like symptom of hyperarousal due to concerns that it would potentially lead to an increase in the diagnosis of ADHD. In general, such criteria have sparked an incredibly productive line of research demonstrating phenomenological differences (episodic vs. chronic course, euphoric vs. irritable mood) and initiating discussions that are relevant to clinicians and researchers alike (Dickstein, 2010; Leibenluft, 2011; Masi et al., 2008).

Treatment of bipolar disorder in youth

Pharmacological therapy

Appropriate treatment for children and adolescents with bipolar disorder has essential benefit with regard to school performance, academic or occupational impairment, relationship stress, comorbid substance use, and prevention of suicides. Pharmacotherapy of mania comprises so-called mood stabilizers (e.g. lithium), atypical or second-generation antipsychotics (SGAs) and typical antipsychotics (chlorpromazine). The use of mood stabilizers or antipsychotics in the treatment of children and adolescents appears to be of limited value when a comorbid condition such as ADHD occurs, unless aggressive behavior is the target symptom (Consoli et al., 2007).

Adverse subjective effects play a central role in the experience of taking antipsychotic drugs (Moncrieff et al., 2009). In adults, second-generation antipsychotics (SGAs) have shown a good benefice/risk ratio in bipolar disorder with a low frequency of extrapyramidal motor syndrome (EPS) and a moderate frequency of metabolic adverse effects such as metabolic syndrome and diabetes. Yet limited knowledge is available on the use of SGAs in children and adolescents. To assess the benefice/risk ratio of SGAs in children and adolescents, a Bayesian meta-analysis with a total of 4015 patients recently analyzed 41 short-term (3-12 weeks) controlled studies that evaluated SGAs adverse effects in youths, including 12 in youths with bipolar disorder (Cohen et al., submitted for print).

Compared with adults, youths were found to be more vulnerable to adverse effects of SGAs. All SGAs increased the risk of somnolence/sedation. Furthermore, substance-specific significant treatment-related changes compared with placebo were observed regarding weight gain, metabolic variables (including prolactin) and extrapyramidal-motor symptoms.

Second-generation antipsychotics (SGAs) represent an efficacious treatment for children and adolescents with bipolar disorder, whereby different tolerability profiles should be considered in making treatment decisions (Cohen et al., submitted for print).

Non-pharmacological therapies

Besides pharmacological treatment, educational and psychosocial strategies including psychotherapy, promotion of compliance with treatment, and education of patients and their families, are essential in the treatment of bipolar disorder in youth in order to improve the treatment outcome.

In case of no response to pharmacological treatment, electroconvulsive therapy (ECT) has proven to be a safe and effective treatment for both manic and depressive episodes in adolescents with severe illness (Cohen et al., 1997). Regarding the long-term outcome of adolescents who receive ECT, findings suggest that adolescents given ECT for bipolar disorder do not differ in subsequent school and social functioning from carefully matched controls (Taieb et al., 2002), and adolescents treated with ECT do not suffer measurable cognitive impairment at long-term follow-up (Cohen et al., 2000). In addition, an assessment of patients´ and parents´ experiences and attitudes towards the use of ECT in adolescence indicates that, despite negative views about ECT in public opinion, adolescent recipients and their parents share overall positive attitudes towards ECT (Taieb et al., 2001).

Future perspectives

In the past decade, structural and functional imaging studies via magnetic resonance (MRI, fMRI) have yielded greater understanding of the neurobiology of bipolar disorder in children and adolescents. Since current findings indicate that youths with bipolar disorder have fundamental alterations in the brain/behaviour interactions that underlie emotional processing, future studies could evaluate how medications or psychotherapies can ameliorate these brain/behaviour interactions (Dickstein, 2010). The European College of Neuropsychopharmacology (ECNP) supports networks of clinicians who seek to improve treatment in children with bipolar disorder. Since early intervention may improve diagnosis, treatment studies are an important objective for future research in Europe (Goodwin et al., 2008).

Conclusion

In recent years, a considerable increase in the number of children and adolescents evaluated, diagnosed and treated for bipolar disorder has been noted.

Bipolar-like symptoms are quite frequent in prepubertal children, but the age at which bipolar disorder can first be diagnosed remains controversial. Current neurobiological findings have advanced our understanding of emotional function and dysfunction in youth.

Developmental aspects and environmental factors are crucial regarding the onset and progression of bipolar disorder in children and adolescents. From a developmental view, bipolar disorder in adolescents and so-called ‘paediatric bipolar disorder’ are not the same disorder or two disorders related in a common continuum.

Differential diagnosis is important to distinguish bipolar disorder from Attention Deficit Hyperactivity Disorder (ADHD) or conduct disorders in children and adolescents.

Treatment of bipolar disorder in youths comprises pharmacological and non-pharmacological strategies. Differences in the tolerability profiles of medications should be considered in making treatment decisions and optimizing the benefice/risk ratio.

In coming years, recognising and diagnosing bipolar disorder in children should be more strongly based on biological markers such as brain structure and neural circuits. Combined with clinical history, this approach is expected to result in improved, more specific and accurate diagnosis and treatment.

Like this:

ScienceDaily (July 11, 2011) — Mood swings are not always best understood as an illness called ‘bipolar disorder’, and medication is not the only way to cope with them, says a British Psychological Society report. The report, Understanding Bipolar Disorder, which the Society has made available as a free download throughout the month of July, gives new hope to people diagnosed with bipolar disorder (about 1 to 2 percent of the population).

This in-depth review of recent research was authored by Professor Steven Jones of Lancaster University and a team of leading clinical psychologists, working in partnership with service users. It suggests that a tendency to extreme moods can have significant benefits as well as sometimes leading to problems.

Many people who have been reported as having the diagnosis are also extremely creative and successful individuals. Examples include government press advisor Alistair Campbell, actress Carrie Fisher, actor Stephen Fry, comedian Paul Merton, and television presenters Gail Porter and Bill Oddie.

The report also suggests that these mood swings are more extreme forms of the variations we all experience and can result from life events rather than just brain chemistry. It is not always helpful to think of this as an ‘illness’, and doctors and other health workers may sometimes give unhelpfully negative messages about what the diagnosis means, for example encouraging people to lower their expectations of what they can achieve in life.

The report also suggests that although medication can be helpful for some people, it does not help everyone. Some people prefer instead to think of themselves simply as someone who tends to experience more extreme lows and highs than others, and to manage this by adapting their lifestyle or using psychological therapy.

The report argues that clinical services need to recognise the expertise of service users and work with them towards their own individual goals. One of the authors, Joanne Hemmingfield, said: “As a service user myself I believe that this report provides a message of hope for people with bipolar disorder which is in stark contrast to the messages most people have received in the past.”

Clare Dolman, Chair of MDF the Bipolar Organisation, said: “As the national bipolar charity, we welcome this report by some of the UK’s most distinguished psychologists, led by Professor Steve Jones of the Spectrum Centre. It is very encouraging that ‘Understanding Bipolar Disorder’ highlights the potential positive aspects of living with the condition as well as the negative, and paints a more hopeful picture of the path to recovery by combining psychological approaches with medication where necessary.

“The report offers a clear and accessible account of the psychological perspective and we would recommend anyone interested in gaining a more comprehensive understanding of the condition to read it.”

ScienceDaily (June 2, 2008) — A study from the Massachusetts General Hospital (MGH) supports previous reports that adolescents with bipolar disorder are at increased risk for smoking and substance abuse. The article appearing in the June Drug and Alcohol Dependence — describing the largest such investigation to date and the first to include a control group — also indicates that bipolar-associated risk is independent of the risk conferred by other disorders affecting study participants.

“This work confirms that bipolar disorder (BPD) in adolescents is a huge risk factor for smoking and substance abuse, as big a risk factor as is juvenile delinquency,” says Timothy Wilens, MD, director of Substance Abuse Services in MGH Pediatric Psychopharmacology, who led the study. “It indicates both that young people with BPD need to carefully be screened for smoking and for substance use and abuse and that adolescents known to abuse drugs and alcohol — especially those who binge use — should also be assessed for BPD.”

It has been estimated that up to 20 percent of children and adolescents treated for psychiatric problems have bipolar disorder, and there is evidence that pediatric and adolescent BPD may have features, such as particularly frequent and dramatic mood swings, not found in the adult form of the disorder.

While elevated levels of smoking and substance abuse previously have been reported in young and adult BPD patients, it has not been clear how the use and abuse of substances relates to the presence of BPD or whether any increased risk could be attributed to co-existing conditions such as attention-deficit hyperactivity disorder (ADHD), conduct disorder or anxiety disorders.

The current study analyzes extensive data — including family histories, information from primary care physicians, and a detailed psychiatric interview — gathered at the outset of a continuing investigation following a group of young BPD patients into adulthood. In addition to 105 participants with diagnosed BPD, who enrolled at an average age of 14, the study includes 98 control participants of the same age, carefully screened to rule out mood disorders.

Incidence of each measure — alcohol abuse or dependence, drug abuse or dependence, and smoking — was significantly higher in participants with BPD than in the control group.

Overall, rates of substance use/abuse were 34 percent in the bipolar group and 4 percent in controls. When adjusted to account for co-occurring behavioral and psychiatric conditions, the results still indicated significantly higher risk in the bipolar group. Analyzing how the onset of bipolar symptoms related to when substance abuse began, revealed that BPD came first in most study participants.

The data also indicated that bipolar youth whose symptoms began in adolescence were more likely to abuse drugs and alcohol than were those whose symptoms began in childhood. “It could be that the onset of mood dysregulation in adolescence puts kids at even higher risk for poor judgement and self-medication of their symptoms,” Wilens says. “It also could be that some genetic switch activated in adolescence turns on both BPD and substance abuse in these youngsters. That’s something that we are currently investigating in genetic and neuroimaging studies of this group.”

He adds that clarifying whether bipolar disorder begins before substance abuse starts could have “a huge impact. If BPD usually precedes substance abuse, there may be intervention points where we could reduce its influence on drug and alcohol abuse.

Aggressive treatment of BPD could cut the risk of substance abuse, just as we have shown it does in ADHD.” Wilens is an associate professor of Psychiatry at Harvard Medical School.

The National Institute of Mental Health is supporting the long-term study of bipolar youth of which this report is one phase. Co-authors of the Drug and Alcohol Dependence article are Joseph Biederman, MD, Joel Adamson, Aude Henin, Stephanie Sgambati, Robert Sawtelle, Alison Santry and Michael Monuteaux, ScD, MGH Pediatric Psychopharmacology; and Martin Gignac, MD, University of Montreal.

ScienceDaily (May 3, 2012) — The problems of living with bipolar have been well documented, but a new study by Lancaster University has captured the views of those who also report highly-valued, positive experiences of living with the condition.

Researchers at Lancaster’s Spectrum Centre, which is dedicated to the study of bipolar disorder, interviewed and recorded their views of ten people with a bipolar diagnosis, aged between 24 and 57. Participants in the study reported a number of perceived benefits to the condition ranging from to sharper senses to increased productivity.

The research was designed to explore growing evidence that some people with bipolar value their experiences and in some cases would prefer not to be without the condition.

Participants described a wide range of experiences and internal states that they believed they felt to a far greater intensity than those without the condition. These included increased perceptual sensitivity, creativity, focus and clarity of thought.

Some held (or had previously held) high functioning professional jobs or had been studying for higher level qualifications. They described in detail how they experienced times when tasks that are usually quite difficult or time consuming, would feel incredibly easy and the ability to achieve at a high level during these times was clearly immensely rewarding.

Others expressed the view that they felt ‘lucky’ or even ‘blessed’ to have the condition.

Alan, (not his real name) one of the interviewees, said: “It’s almost as if it opens up something in the brain that isn’t otherwise there, and I see colour much more vividly than I used to……So I think that my access to music and art are something for which I’m grateful to bipolar for enhancing. It’s almost as if it’s a magnifying glass that sits between that and myself.”

Researchers even found some people with bipolar reaped positive experiences from their lows such as greater empathy with the suffering of others.

Dr Fiona Lobban, who led the study, said: “Bipolar Disorder is generally seen as a severe and enduring mental illness with serious negative consequences for the people with this diagnosis and their friends and family. For some people this is very much the case. Research shows that long term unemployment rates are high, relationships are marred by high levels of burden on family and friends and quality of life is often poor. High rates of drug and alcohol misuse are reported for people with this diagnosis and suicide rates are twenty times that of the general population.

“However, despite all these factors researchers and clinicians are aware that that some aspects of bipolar experiences are also highly valued by some people. We wanted to find out what these positive experiences were.

“People were very keen to take part in this study and express views which some felt had to be hidden from the medical profession.

“It is really important that we learn more about the positives of bipolar as focusing only on negative aspects paints a very biased picture that perpetuates the view of bipolar as a wholly negative experience. If we fail to explore the positives of bipolar we also fail to understand the ambivalence of some people towards treatment.”

Rita Long from Stockport was not part of the study but can identify with its findings. She was 40 when she was diagnosed with the condition but from her school days she was aware that she experienced the world differently to her twin sister.

“We were making Christmas cakes at school and I was so interested and excited by it and my sister says she remembers watching me and thinking, ‘I really wish I could get that excited about making a Christmas cake’. I noticed things, experienced them with a different level of intensity, we’d be on a walk and I’d be saying look at the colour of this, and my sister would be saying, ‘It’s just a berry’. Socially too, people with bipolar can be quite quick witted, humorous. Until much later in life I just presumed those things were part of my personality.

“I don’t want to underestimate how difficult the bad times can be that some people go through with bipolar but at the same time I feel very passionate about the positives. If we are going to move on as a society — in academia, in business, in entertainment — we need people who will push boundaries. People with bipolar can do that.”

Like this:

By TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on May 14, 2012

People who suffer from an anxietydisorder in addition to bipolar disorder are more likely to have severe symptoms of bipolar, such as suicidal behavior, more manic episodes, and more depressive episodes, according to new research led by Regina Sala, M.D. at the New York State Psychiatric Institute of Columbia University.

Individuals with both disorders were also twice as likely to be admitted into an emergency room for their bipolar-related depression.

According to the study, about 60 percent of people with bipolar disorder have experienced an anxiety disorder at least once in their lifetime, and 40 percent have had two or more anxiety disorders in their lifetime.

Researchers looked at the symptoms and treatments of 1600 adults with bipolar disorder who were part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Compared to individuals with bipolar disorder who never had anxiety, people with both disorders were also more likely to have substance abuse problems and social problems, such as problems at work.

The authors believe that that early detection of anxiety disorders in people with bipolar disorder is necessary. Treating the anxiety disorder may help ease at least part of the burden of bipolar disorder.

The study is published in the Journal of Psychiatric Research and was supported by grants from the Alicia Koplowitz Foundation and the National Institutes of Health.

The disorder can cause great distress among those afflicted and those living with them.

Bipolar disorder can be a disabling condition, with a higher-than-average risk of death through suicide. The difference between bipolar disorder and unipolar disorder (also called major depression) is that bipolar disorder involves both elevated and depressive mood states.

For more information about the topicBipolar disorder, read the full article at Wikipedia.org,

Like this:

ScienceDaily (Dec. 21, 2011) — An international team of scientists, led by researchers at the University of California, San Diego School of Medicine, reports that abnormal sequences of DNA known as rare copy number variants, or CNVs, appear to play a significant role in the risk for early onset bipolar disorder.

The findings were published in the December 22 issue of the journalNeuron.

CNVs are genomic alterations in which there are too few or too many copies of sections of DNA. Researchers have known that spontaneously occurring (de novo)CNVs — genetic mutations not inherited from parents — significantly increase the risk for some neuropsychiatric conditions, such as schizophrenia or the autism spectrum disorders. But their role was unclear in bipolar disorder, previously known as manic depression.

Principal investigator Jonathan Sebat, PhD, assistant professor of psychiatry and cellular and molecular medicine at UC San Diego’s Institute of Genomic Medicine, and colleagues, found that de novoCNVs contribute significant genetic risk in about 5 percent of early onset bipolar disorder, which appears in childhood or early adulthood.

In other words, said the study’s first author Dheeraj Malhotra, assistant project scientist in Sebat’s lab, “having a de novomutation increases the chances of having an earlier onset of disease.”

The cause or causes of bipolar disorder remain unclear. There is a clear genetic component — the disease runs in families — but previous studies that have focused mainly on common inherited variants have met with limited success in identifying key susceptibility genes.

Malhotra said that — while the findings do not conclusively pinpoint a specific gene or genomic region -the new findings show “convincing” evidence that rare copy number mutations strongly contribute to the development of early onset bipolar disorder. He added that sequencing of complete genomes or exomes of large number of bipolar families is needed to determine the total genetic contribution of all forms of de novomutation to risk for bipolar disorder.

Funding for this research came, in part, from the National Institutes of Health, Ted and Vada Stanley, the Beyster family foundation, Wellcome Trust, Science Foundation Ireland, the Sidney R. Baer, Jr. Foundation and the Essel Foundation.

Like this:

ScienceDaily (Oct. 25, 2011) — Low levels of a brain protein that regulates gene expression may play a role in the origin of bipolar disorder, a complex and sometimes disabling psychiatric disease. As reported in the latest issue of Bipolar Disorders, the journal of The International Society for Bipolar Disorders, levels of SP4 (specificity protein 4) were lower in two specific regions of the brain in postmortem samples from patients with bipolar disorder. The study suggests that normalization of SP4 levels could be a relevant pharmacological strategy for the treatment of mood disorders.

“We found that levels of SP4 protein in the brain’s prefrontal cortex and the cerebellum were lower in postmortem samples from patients with bipolar disorder, compared with samples from control subjects who did not have the disease,” said co-senior author Grace Gill, PhD, an associate professor in the department of anatomy and cellular biology at Tufts University School of Medicine and a member of the neuroscience; genetics; and cell, molecular and developmental biology program faculties at the Sackler School of Graduate Biomedical Sciences at Tufts.

Gill’s laboratory team at Tufts collaborated with researchers from Spain and used postmortem samples from Spain’s University of the Basque Country brain collection program to examine SP4 protein levels in samples from 10 bipolar subjects and 10 control subjects matched for gender, age, and time since death.

The team focused on the prefrontal cortex and the cerebellum because brain imaging studies suggest that bipolar disorder is associated with changes in the structure of these brain regions. Little is known about the cellular and molecular changes that occur in bipolar disorder, especially in the cerebellum.

“Our findings suggest that reduced activity of the SP4 protein may be common in bipolar disorder,” stated co-senior author Belén Ramos, PhD, a former postdoctoral fellow in Gill’s lab and now a researcher at the Parc Sanitari Sant Joan de Déu (PSSJD) and the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) in Barcelona, Spain.

Ramos explained that SP4 belongs to a category of proteins known as transcription factors, which regulate gene expression. “While this study examined the SP4 protein levels, mutations in the gene encoding the SP4 protein have been associated with psychiatric diseases including bipolar disorder, a poorly understood disease characterized by episodes of abnormally elevated energy levels with or without depressive episodes, as well as schizophrenia, and major depressive disorder. Thus, our study adds to the growing body of evidence that alterations in gene regulation contribute to the development of psychiatric disorders,” said Ramos.

Further analysis showed that SP4 levels are regulated by neuronal activity, indicating that this transcription factor is important for normal neuronal signaling. “Looking at normal rat neurons in culture, we found that SP4 is rapidly degraded by enzymes in the absence of neuronal signaling, which we refer to as the non-depolarized state,” said first author Raquel Pinacho, BS, MS, a graduate student in Ramos’ lab in PSSJD.

In previous work, the researchers had identified an essential role for SP4 in regulating the structure of nerve cells during development. Taken together, the findings suggest that reduced levels of this protein may contribute to altered patterns of nerve cells in the brain.

“Moreover,” added Ramos, “we demonstrated that the destruction of SP4 by enzymes was inhibited by lithium, a drug widely used as a mood stabilizer for patients with bipolar disorder. When lithium was added to cells in the non-depolarized — inactive — state, levels of SP4 were stabilized and increased. This finding suggests that the therapeutic effects of lithium may be related, at least in part, to changes in gene expression leading to changes in cellular structure and function.”

In addition to measuring levels of SP4, Gill and colleagues assessed levels of SP1, a related transcription factor protein that has been reported to be altered in schizophrenia. Like SP4, SP1 was reduced in the cerebellum of subjects with bipolar disorder. According to the authors, this finding suggests that both factors may be relevant transcriptional regulators, low levels of which may contribute to the pathogenesis of bipolar disorder and other psychiatric diseases. However, unlike SP4, levels of SP1 did not appear to be regulated by neuronal activity, highlighting the complexity of the mechanisms involved in functional specificity in the SP transcription factor family.

Additional authors on the study are Nuria Villalmanzo, a research assistant in Ramos’s lab in PSSJD, Jasmin Lalonde, PhD, a postdoctoral fellow in Gill’s lab at TUSM; Josep Maria Haro, MD, PhD, of PSSJD and CIBERSAM; and J. Javier Meana, MD, PhD, professor in the department of pharmacology at the University of the Basque Country in Bizkaia, Spain, and CIBERSAM.

The study was funded by the National Institute of Child Health and Human Development, part of the National Institutes of Health, a Marie Curie International Reintegration Grant (European Union) and the Plan National de Investigación (Spain). This study was also supported by fellowships to authors from the Spanish Ministry of Science and Education /Fulbright, CIBERSAM, and from the Canadian Institutes of Health Research.

Like this:

ScienceDaily (Dec. 13, 2011) — A new study provides support for a bi-directional pathway between non-medical prescription opioid use and opioid-use disorder due to non-medical use and several mood anxiety disorders.

Individuals suffering from mood and anxiety disorders such as bipolar, panic disorder and major depressive disorder may be more likely to abuse opioids, according to a new study led by researchers from the Johns Hopkins Bloomberg School of Public Health. They found that mood and anxiety disorders are highly associated with non-medical prescription opioid use. The results are featured in a recent issue of theJournal of Psychological Medicine.

Prescription opioids such as oxycontin are a common and effective treatment for chronic and acute pain. Non-medical use of prescription opioids has increased dramatically and, according to the Substance Abuse and Mental Health Services Administration, prescription opioids are the second most frequently used illegal drug in the U.S. after marijuana. Prescription opioids are highly addictive and prolonged use can produce neurological changes and physiological dependence. For the study, researchers examined the association between individuals with mood and anxiety disorders with non-medical prescription opioid use and opioid disorder.

“Lifetime non-medical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders. Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders,” said Silvia Martins, MD, PhD, lead author of the study and an associate scientist with the Bloomberg School’s Department of Mental Health. “However, there is also evidence that the association works the other way too. Increased risk of incident opioid disorder due to non-medical use occurred among study participants with baseline mood disorders, major depressive disorder, dysthymia and panic disorder, reinforcing our finding that participants with mood disorders might use opioids non-medically to alleviate their mood symptoms. Early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder.”

Using data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC), a longitudinal face-to-face survey of individuals aged 18 years and older between 2001 to 2002 and 2004 to 2005, researchers assessed participants for a history of psychiatric disorders. Non-medical use of prescription opioids was defined to participants as using a prescription opioid without a prescription or in greater amounts more often or longer than prescribed or for a reason other than a doctor’s instruction to use them. Logistic regression was used to determine whether lifetime non-medical prescription opioid use and opioid disorders due to this use predicted incident mood and anxiety disorders and the reverse. Researchers believe these findings provide support for a bi-directional pathway between non-medical prescription opioid use and opioid-use disorder due to non-medical use and several mood and anxiety disorders.

“With the current increased use of non-medical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern. Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders,” said Carla Storr, ScD, author of the study and an adjunct professor with the Bloomberg School’s Department of Mental Health. Individuals using prescription opioids need to be closely monitored not only for the possibility of engaging in non-medical use, but also for the development of co-morbid psychiatric disorders.

“Additional studies are needed to examine the relationship between non-medical prescription opioid use and prescription opioid-use disorder with mood and anxiety disorders since they could co-occur due to shared genetic or environmental risk factors,” Martins adds.

The research was supported by grants from the National Institute on Drug Abuse and by the New York State Psychiatric Institute.

I am medical doctor and hypnotherapist with more than 17 years experience. Feel free to send me email (guide.rehab@gmail.com) to discuss your situation.

ScienceDaily (Dec. 5, 2011) — Experiencing a psychiatric episode within the first 30 days post-partum appears to be associated with an increased risk of developing bipolar affective disorder, according to a report published Online First byArchives of General Psychiatry, one of theJAMA/Archives journals.

“Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of post-partum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change,” the authors write as background information in the article. “It is also clear, however, that a high number of women with the new onset of a psychiatric disorder in the immediate post-partum period do not receive a diagnosis of bipolar disorder.”

Trine Munk-Olsen, Ph.D., of the National Centre for Register-Based Research, Arhus University, Arhus, Denmark, and colleagues collected data on 120,378 women born in Denmark from 1950 to 1991 who were alive in 2006 and had a history of a first-time psychiatric contact with any type of psychiatric disorder (admission or outpatient contact) with any type of psychiatric disorder excluding bipolar affective disorder. Each woman was followed up with individually from the day of discharge, with data collected on inpatient or outpatient psychiatric contacts during the follow-up period.

A total of 2,870 of these women had their initial psychiatric contact within the first year after delivery of their first child. During follow-up, 3,062 of the 120,378 women received diagnoses of bipolar affective disorder, of which 132 had their initial psychiatric contact 0 to 12 months post-partum. After adjusting for first diagnosis and family history of psychiatric illness, conversion rates to bipolar disorder were significantly predicted by the timing of initial psychiatric contact. The authors found a significantly higher conversion rate to bipolar affective disorder in women having their initial contact within the first post-partum month. Additionally, the authors found evidence that the severity of the initial post-partum psychiatric episode may be important, as inpatient admissions were associated with a higher conversion rate than were outpatient contacts.

Fifteen years after initial contact, 13.87 percent of women with onset in the immediate post-partum period (0 to 30 days) had converted to bipolar disorder, 4.69 percent of women with later onset (31 to 365 days post-partum) and 4.04 percent of women with onset at other points had converted to bipolar disorder. Additionally, an extended analysis showed that 18.98 percent of women with onset in the immediate post-partum period had converted to bipolar disorder within 22 years after initial psychiatric contact. Conversely, 6.51 percent of women with later post-partum onset and 5.43 percent of women with onset at other points had converted to bipolar disorder after 22 years.

“The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days post-partum significantly predicted conversion to bipolar affective disorder during the follow-up period,” the authors conclude. “Results indicate that the presentation of mental illness in the early post-partum period is a marker of possible underlying bipolarity.”